Background: Referral between primary care and hospitals is of great importance for patient care and follow-up. This study was conducted because of the importance of the quality of referral letters and feedback reports.
Objectives: To evaluate the quality of referrals from primary health care (PHC) centers to general hospital in four regions in Saudi Arabia.
Methods: This was a cross-sectional study of a random sample of referrals from the PHC centers. The first sampling unit was the general hospitals to which the health centers refer. A random sample of health centers was then selected based on their distance from the hospitals. This was followed by randomly selecting 30 referrals from each health center. The referral letters and the corresponding feedback reports were then studied for quality by scoring the components of each. The data was entered in a personal computer using the Stat Pack Gold Statistical Package. The chi-square was used to compare the different scores across the regions and T-test was used to compare the cumulative scores.
Main outcome measures: The quality of referral letters and feedback reports was defined according to the standardized components using a scoring system.
Results: The most frequently mentioned items in the referrals were demographic data (100%), specialty referred to (93.3%) and reason for referral (82.7%). Other important items in the feedback reports including the name of the treating physician (81.8%), diagnosis (86.0%), and decision on follow-up (80%) were missing. The quality of referral letters was poor in 23%, with 81% as the corresponding figure for the feedback reports with some variation between the different regions.
Conclusions: The quality of referral letters and feedback reports is poor and needs to be improved. This can be achieved through implementing the quality assurance programme.

Objective: To determine the factors that significantly discriminate between Ministry of Health (MOH) and private primary health care patients in Riyadh City, Saudi Arabia.
Methodology: Through a self-administered questionnaire, data were collected from 408 randomly selected patients in five MOH primary health care centers and five private dispensaries. Data collection was conducted from February 15 to March 15, 1998. Two-group stepwise discriminant analysis was utilized in analyzing the data.
Results: Seven of the 33 factors were found to be statistically significant in discriminating between MOH and private patients. These factors were: (1) source of payment, (2) availability of other sources of income, (3) distance between residence and Primary Health Care (PHC) provider, (4) education, (5) preference for similar-gender doctors, (6) preference for Saudi doctors, and (7) perceived quality of medical staff.
Conclusion: The study notes that PHC providers cannot control the sociodemographic characteristics of patients. Therefore, policy makers should focus on ensuring that PHC facilities have enough male and female doctors. Furthermore, the quality of the medical staff of these facilities should be upgraded to improve the overall quality of the services they provide. The conduct of further studies related to the utilization of health care providers is also recommended.

Trends in perinatal mortality at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia: A ten years study

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Fathiya M Al-Mejhim, Sulaiman S Al-NajashiPMID:23008587

Objective: The aim of the study is to identify the major causes of perinatal mortality and to determine the main maternal factors which affect perinatal mortality at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
Methods: A retrospective study was conducted covering a period of ten years from January 1987 to December 1996. All 548 perinatal deaths, which occurred during that period, were analyzed according to Wigglesworth classification.
Results: The study revealed a perinatal mortality rate of 19.2:1,000 births. Lethal malformations accounted for 116 (21.1%) of fetal deaths. Of the remaining 432 deaths, 214 (49.5%) occurred antenatally, 71 (16.5%) in labour and 147 (34%) within the first week of delivery. Amongst the normally formed babies, low birth weight was the commonest cause of death (29%) followed by the consequences of maternal diseases (14.8%). The cause of death was unknown in 17.3% of mature babies who died. Unbooked patients were responsible for 72% of the total perinatal deaths.
Conclusion: Reduction of the perinatal mortality rate is possible when all women begin to value preconception counselling and attendance at antenatal clinics.

Objective: To determine the possibility of any association between HBV, HCV, elevated aminotransferase enzymes and Oral Lichen Planus (OLP)patients in Eastern Saudi Arabia.
Design: Sera were collected from OLP patients, to be tested for HbsAg, anti-HCV and ALT/AST levels.
Settings: All the patients who were diagnosed clinically in periodontal section, Dammam Central Hospital were from Eastern Saudi Arabia. The histopathological diagnosis was done in Histopathology Section, Dammam Regional Labs, the virological studies in the Virus Diagnosis Lab of Dammam Regional Labs and Blood Bank, and the aminotransferase tests done in the Dammam Central Hospital Labs.
Subjects: 34 serum specimens were collected from OLP patients, and 32 other samples from healthy populations of the same age and sex as the controls of the study. Results: Incidence of HBsAg, anti-HCV, HBsAg+HCV, and elevated aminotransferase enzymes among OLP patients were 8.8%, 14.7%, 2.9%, and 47.05% respectively and the results from the control subjects were 6.25%, 3.12%, 0%, and 3.12% respectively.
Conclusion: There is a significant association between OLP and HCV infection. No clear evidence of this relationship appeared with HBV. All the aminotransferase elevated samples were positive to HCV, giving a clear evidence of the association of chronic HCV infection with the OLP. Aminotransferase elevated results could be used as a clue to clinical signs of asymptomatic hepatopathies, and as a marker to check the OLP cases for the relevant Hepatic Viruses. Despite the limited number of OLP patients in this study, the results could highlight the problem in this geographical area of the world. We recommend a comprehensive study to be carried out using this current study as a preliminary one.

Background: Hereditary diseases form an omnibus problem in Arab societies in general and in rural Arab societies in particular.
Aim: Study of hereditary blindness and its relation to endogamous marriage among the Gharaghir tribe in the Jordan valley.
Methodology: The researchers carried out a fieldwork among the Gharaghir tribe in Al-Sawalha (the northern valley region, Deir Alla, the Hashemite Kingdom of Jordan) using participant observation, and intensive focussed interviews, in addition to the genealogical method. We gathered data on endogamous marriages, blindness, genealogy and the degrees of kinship between the spouses.
Results and Discussion: The results show that blindness among the Gharaghir was found to be associated with endogamous marriage. Marriage among the established ancestors of the clans used to be exogamous and kinship was unilineal-patrilineal. Through the shift to endogamy (marriage between close kin) there was a shift from uniliny (patriliny) to bilineal descent. This may have increased the probability of a recessive gene transmission from both parental sides. This is evidenced by the high inbreeding coefficient of 0.0687, one of the highest recorded.

Choosing a medical career: What influences secondary school female graduates?

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Badria K Al-DabalPMID:23008590

Objective: To assess attitudes and reasons of secondary school female students for choosing medicine as a career.
Design: A cross-sectional study with a sample of 191 female students, who responded to an administered questionnaire.
Results: The mean age of the students was 18.3 ± 0.94. The mean general average test scores for female students who applied to medicine, MLT and Nursing was 94.02%, 91.26% and 86.78% respectively. Personal interest was the main reason in 85.7% of the applicants. Only 109 students (57.1%) of the study group have any knowledge about the profession of Medicine. One hundred sixty one of the students (84.3%) expected difficulties in their studies.
Conclusion: The study showed that personal interest was the main reason behind the students' choice. A sizable proportion had no knowledge of the specialty they opted for, while more than 80% of the applicants anticipated some difficulties upon entering the Medical College. The majority of MLT applicants were not interested in nursing as a specialty. The current strategy for educating secondary school female students about Medical College programmes should be strengthened.